=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710285010
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABUNDANT CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2011
-----------------------------------------------------
Last Update Date | 12/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5200 PARK AVE STE 102
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38119-3505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-820-0701
-----------------------------------------------------
Fax | 901-820-0709
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5200 PARK AVE STE 102
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38119-3505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-820-0701
-----------------------------------------------------
Fax | 901-820-0709
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JESSICA YVETTE MICKEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-820-0701
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 1000000008243
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------